Robert Fndkyan injured his cervical spine, thoracic spine, lumbar spine, bilateral shoulders and bilateral wrists. His case resolved in 2016 by a Compromise and Release and his entitlement to a SJDV was not resolved in the Order.
In 2015, before the case was settled, a QME report specified permanent disability impairment ratings for various body parts. He further opined that applicant should have prophylactic work preclusions:... for the cervical, thoracic, and lumbar spines: No very heavy lifting; or repeated bending or stooping. For the bilateral shoulders ... : No repetitive at or above shoulder reaching or work. For the bilateral wrists ... : No repetitive forceful gripping or grasping.
After the case was settled, he demanded a Supplemental Job Displacement Voucher (SJDV), which was denied by the defendant.
The WCJ found that applicant was not entitled to a SJDV because there was no evidence that a Physician's Return-to-Work and Voucher (Physician's RTW) form was sent to or received by defendant.
A petition for reconsideration was granted, and the WCAB reversed finding that Fndkkyan was entitled to the SJDV in the case of Fndkyan v Opus One Labs.
The sole issue at trial was whether applicant is entitled to a SJDV when a Physician's RTW form was not sent to or received by defendant.
The WCJ correctly points out that Labor Code section 4658.7(b)(l) specifically provides that an employer's obligation to offer regular, modified, or alternative work in lieu of a SJDV is to be made no later than 60 days after receipt of a medical report "in the form created by the administrative director" finding that the disability from all conditions has become permanent and stationary and has caused permanent partial disability. (Lab. Code, § 4658.7(b)(l). This form is described as a "mandatory attachment" to a medical report and that informs the employer of work capacities and restrictions relevant to regular, modified, or alternative work.
The WCJ also correctly points out that AD Rule 10133.31(b) specifies that this form is identified as the Physician's Return-to-Work & Voucher Report.
In this instance, defendant had the burden to obtain a Physician's RTW form when defendant was apprised of applicant's permanent disability status and work preclusions in the QME report. "To conclude otherwise would place form over substance."
...
In 2015, before the case was settled, a QME report specified permanent disability impairment ratings for various body parts. He further opined that applicant should have prophylactic work preclusions:... for the cervical, thoracic, and lumbar spines: No very heavy lifting; or repeated bending or stooping. For the bilateral shoulders ... : No repetitive at or above shoulder reaching or work. For the bilateral wrists ... : No repetitive forceful gripping or grasping.
After the case was settled, he demanded a Supplemental Job Displacement Voucher (SJDV), which was denied by the defendant.
The WCJ found that applicant was not entitled to a SJDV because there was no evidence that a Physician's Return-to-Work and Voucher (Physician's RTW) form was sent to or received by defendant.
A petition for reconsideration was granted, and the WCAB reversed finding that Fndkkyan was entitled to the SJDV in the case of Fndkyan v Opus One Labs.
The sole issue at trial was whether applicant is entitled to a SJDV when a Physician's RTW form was not sent to or received by defendant.
The WCJ correctly points out that Labor Code section 4658.7(b)(l) specifically provides that an employer's obligation to offer regular, modified, or alternative work in lieu of a SJDV is to be made no later than 60 days after receipt of a medical report "in the form created by the administrative director" finding that the disability from all conditions has become permanent and stationary and has caused permanent partial disability. (Lab. Code, § 4658.7(b)(l). This form is described as a "mandatory attachment" to a medical report and that informs the employer of work capacities and restrictions relevant to regular, modified, or alternative work.
The WCJ also correctly points out that AD Rule 10133.31(b) specifies that this form is identified as the Physician's Return-to-Work & Voucher Report.
In this instance, defendant had the burden to obtain a Physician's RTW form when defendant was apprised of applicant's permanent disability status and work preclusions in the QME report. "To conclude otherwise would place form over substance."
...
The WCIRB Governing Committee met this month to review the WCIRB Actuarial Committee’s analysis of December 31, 2018, California workers’ compensation loss and loss adjustment expense experience.
Following review and discussion of the latest data and analysis, the Committee conferred on whether to direct the WCIRB to submit a mid-year 2019 advisory pure premium rate filing to the California Department of Insurance (CDI).
Pure premium rates by definition reflect indemnity and medical losses and loss adjustment expenses only, are advisory and are not required to be adopted by insurance companies. In California’s open rated workers’ compensation insurance market, insurers are largely free to file their own rates and rating plans directly with the CDI.
Recognizing that mid-year filings and adjustments to advisory pure premium rates can be disruptive to employers, agents and brokers as well as insurers, the Committee established a guideline in 2011 stating that mid-year filings would generally not be made by the WCIRB unless there was highly unusual volatility in experience or major legislative, regulatory or judicial action.
Based on the December 31, 2018, experience and analysis, the Committee determined that the overall improvement in experience since the January 1, 2019, approved pure premium rates was more moderate, approximately $0.06 per $100 of payroll or less than 4 percent, than in recent prior years and did not warrant a mid-year 2019 pure premium rate filing.
The Committee also noted in its determination that there are concerns relating to indicated increases in average 2018 claim severities as well as potential distortions in loss development arising from the recent dramatic reductions in pharmaceutical costs.
The Committee instructed the WCIRB to further analyze these areas in preparation for the January 1, 2020, annual pure premium rate filing to be presented to the Committee in August for submission to the CDI.
The Actuarial Committee’s analysis of December 31, 2018, experience is publicly available to all stakeholders as are the documents from today’s Committee meeting, including the agenda and materials presented at the meeting, on the Committee Documents page of the WCIRB website ...
Following review and discussion of the latest data and analysis, the Committee conferred on whether to direct the WCIRB to submit a mid-year 2019 advisory pure premium rate filing to the California Department of Insurance (CDI).
Pure premium rates by definition reflect indemnity and medical losses and loss adjustment expenses only, are advisory and are not required to be adopted by insurance companies. In California’s open rated workers’ compensation insurance market, insurers are largely free to file their own rates and rating plans directly with the CDI.
Recognizing that mid-year filings and adjustments to advisory pure premium rates can be disruptive to employers, agents and brokers as well as insurers, the Committee established a guideline in 2011 stating that mid-year filings would generally not be made by the WCIRB unless there was highly unusual volatility in experience or major legislative, regulatory or judicial action.
Based on the December 31, 2018, experience and analysis, the Committee determined that the overall improvement in experience since the January 1, 2019, approved pure premium rates was more moderate, approximately $0.06 per $100 of payroll or less than 4 percent, than in recent prior years and did not warrant a mid-year 2019 pure premium rate filing.
The Committee also noted in its determination that there are concerns relating to indicated increases in average 2018 claim severities as well as potential distortions in loss development arising from the recent dramatic reductions in pharmaceutical costs.
The Committee instructed the WCIRB to further analyze these areas in preparation for the January 1, 2020, annual pure premium rate filing to be presented to the Committee in August for submission to the CDI.
The Actuarial Committee’s analysis of December 31, 2018, experience is publicly available to all stakeholders as are the documents from today’s Committee meeting, including the agenda and materials presented at the meeting, on the Committee Documents page of the WCIRB website ...
A Rancho Cordova registered nurse was indicted and charged with distribution of fentanyl and oxycodone and other opioids as a result of a coordinated operation by the U.S. Attorney’s Office, the Federal Bureau of Investigation, Homeland Security Investigations, the Drug Enforcement Administration, and the U.S. Postal Inspection Service that has identified, disrupted, and prosecuted illegal operators on the darknet.
42 year old Carrie Alaine Markis was a registered California nurse who sold more than 20,000 prescription opioid pills and products on various darknet sites, including Silk Road 2.0, Pandora, and AlphaBay.
Between 2013 and 2016, she purchased legitimate prescriptions from willing sellers. Then, she resold these pills and patches through her darknet business, "Farmacy41," which she ran from her Rancho Cordova home.
Markis’s business operated on Silk Road 2.0 from November 2013 through May 2014. During this time, Markis sent private messages to her customers revealing that she was a licensed California medical professional. She sold more than 8,500 hydrocodone pills and more than 2,500 oxycodone pills. In combination with other sales of morphine, hydromorphone, fentanyl, and methadone, Markis earned about $230,000 in Bitcoin at the time.
Markis’s Farmacy41 business operated on Pandora from December 2013 through August 2014. During this time, she again sold more than 2,500 hydrocodone and more than 2,000 oxycodone pills. In combination with other sales of morphine, hydromorphone, methadone, and fentanyl, she completed about 393 transactions and earned about $122,000 in Bitcoin at the time.
On AlphaBay, Markis operated her Farmacy41 business from November 2015 through April 2016. There, she completed about 262 transactions for hydrocodone, oxycodone, morphine, methadone, and fentanyl. At the time, her Bitcoin earnings were worth about $74,000.
Federal agents searched Markis’s residence on January 24, 2019, and found about $1.8 million in Bitcoin held on a cold storage cryptocurrency wallet. Agents also found about $234,000 in cash. Markis was arrested on a federal complaint and made her initial appearance in court on January 25, 2019.
"The darknet supports an illegitimate commerce system where criminals think they can anonymously traffic dangerous substances and goods into the Unites States," said Ryan L. Spradlin, Homeland Security Investigations Special Agent in Charge for northern California.
Spradlin also claims that since our country is in the midst of a serious opioid addiction crisis; some users will do anything to get their hands on drugs like fentanyl.
"The darknet has become a one-stop shop for individuals peddling powerful opioids, like fentanyl, because of the anonymity it seemingly offers to those who seek to evade detection said DEA Special Agent in Charge Chris Nielsen ...
42 year old Carrie Alaine Markis was a registered California nurse who sold more than 20,000 prescription opioid pills and products on various darknet sites, including Silk Road 2.0, Pandora, and AlphaBay.
Between 2013 and 2016, she purchased legitimate prescriptions from willing sellers. Then, she resold these pills and patches through her darknet business, "Farmacy41," which she ran from her Rancho Cordova home.
Markis’s business operated on Silk Road 2.0 from November 2013 through May 2014. During this time, Markis sent private messages to her customers revealing that she was a licensed California medical professional. She sold more than 8,500 hydrocodone pills and more than 2,500 oxycodone pills. In combination with other sales of morphine, hydromorphone, fentanyl, and methadone, Markis earned about $230,000 in Bitcoin at the time.
Markis’s Farmacy41 business operated on Pandora from December 2013 through August 2014. During this time, she again sold more than 2,500 hydrocodone and more than 2,000 oxycodone pills. In combination with other sales of morphine, hydromorphone, methadone, and fentanyl, she completed about 393 transactions and earned about $122,000 in Bitcoin at the time.
On AlphaBay, Markis operated her Farmacy41 business from November 2015 through April 2016. There, she completed about 262 transactions for hydrocodone, oxycodone, morphine, methadone, and fentanyl. At the time, her Bitcoin earnings were worth about $74,000.
Federal agents searched Markis’s residence on January 24, 2019, and found about $1.8 million in Bitcoin held on a cold storage cryptocurrency wallet. Agents also found about $234,000 in cash. Markis was arrested on a federal complaint and made her initial appearance in court on January 25, 2019.
"The darknet supports an illegitimate commerce system where criminals think they can anonymously traffic dangerous substances and goods into the Unites States," said Ryan L. Spradlin, Homeland Security Investigations Special Agent in Charge for northern California.
Spradlin also claims that since our country is in the midst of a serious opioid addiction crisis; some users will do anything to get their hands on drugs like fentanyl.
"The darknet has become a one-stop shop for individuals peddling powerful opioids, like fentanyl, because of the anonymity it seemingly offers to those who seek to evade detection said DEA Special Agent in Charge Chris Nielsen ...
Oklahoma’s attorney general dropped all but a single claim against Johnson & Johnson and Teva Pharmaceutical Industries Ltd in a closely watched lawsuit alleging the drugmakers helped fuel the U.S. opioid epidemic.
The move by Oklahoma Attorney General Mike Hunter came ahead of an upcoming May 28 trial, the first in the United States to result from roughly 2,000 lawsuits seeking to hold manufacturers of painkillers responsible for contributing to the epidemic.
Hunter dropped the claims after announcing last week that OxyContin maker Purdue Pharma LP had along with the wealthy Sackler family who own it reached a $270 million settlement.
The 2017 lawsuit accused the three companies of engaging in deceptive marketing that downplayed the addiction risk from opioids while overstating their benefits. The Sacklers were not defendants in the case. The companies deny wrongdoing.
Hunter said he would continue to bring a public nuisance claim against J&J and Teva but was dropping five other claims, including that they violated the Oklahoma Medicaid False Claims Act. Hunter said dropping those claims would not impact the amount of damages the state is seeking. Hunter had been asking for more than $20 billion before Purdue’s settlement.
J&J in a statement said the state’s decision to drop most of its claims "underscores their lack of merit." It said the evidence at trial will show that the company appropriately marketed its pain medications.
Teva did not respond to a request for comment.
Hunter said the decision to refocus the case around the single claim that the companies caused a public nuisance that needs remediated will obviate efforts by the companies to delay the upcoming trial.
It will also transform what was to be a televised jury trial into a non-jury one in which a state court judge will decide the case, Hunter said.
More than 1,600 other opioid-related lawsuits are consolidated before a federal judge in Ohio, who has pushed for a settlement ahead of the trial before him in October. Other cases, including Oklahoma’s, are pending in state courts ...
The move by Oklahoma Attorney General Mike Hunter came ahead of an upcoming May 28 trial, the first in the United States to result from roughly 2,000 lawsuits seeking to hold manufacturers of painkillers responsible for contributing to the epidemic.
Hunter dropped the claims after announcing last week that OxyContin maker Purdue Pharma LP had along with the wealthy Sackler family who own it reached a $270 million settlement.
The 2017 lawsuit accused the three companies of engaging in deceptive marketing that downplayed the addiction risk from opioids while overstating their benefits. The Sacklers were not defendants in the case. The companies deny wrongdoing.
Hunter said he would continue to bring a public nuisance claim against J&J and Teva but was dropping five other claims, including that they violated the Oklahoma Medicaid False Claims Act. Hunter said dropping those claims would not impact the amount of damages the state is seeking. Hunter had been asking for more than $20 billion before Purdue’s settlement.
J&J in a statement said the state’s decision to drop most of its claims "underscores their lack of merit." It said the evidence at trial will show that the company appropriately marketed its pain medications.
Teva did not respond to a request for comment.
Hunter said the decision to refocus the case around the single claim that the companies caused a public nuisance that needs remediated will obviate efforts by the companies to delay the upcoming trial.
It will also transform what was to be a televised jury trial into a non-jury one in which a state court judge will decide the case, Hunter said.
More than 1,600 other opioid-related lawsuits are consolidated before a federal judge in Ohio, who has pushed for a settlement ahead of the trial before him in October. Other cases, including Oklahoma’s, are pending in state courts ...
The Division of Workers’ Compensation (DWC) has issued a notice of public hearing for proposed evidence-based updates to the Medical Treatment Utilization Schedule (MTUS), which can be found at California Code of Regulations, title 8, section 9792.23.
The public hearing is scheduled for Monday, May 6 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than Monday, May 6, 2019.
The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:
-- Low Back Disorders Guideline (ACOEM March 7, 2019)
-- Introduction to the Workplace Mental Health Guideline (ACOEM March 13, 2019)
The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online ...
The public hearing is scheduled for Monday, May 6 at 10 a.m. in the auditorium of the Elihu Harris Building, 1515 Clay Street, Oakland. Members of the public may review and comment on the proposed updates no later than Monday, May 6, 2019.
The proposed evidence-based updates to the MTUS incorporate by reference the latest published guidelines from American College of Occupational and Environmental Medicine (ACOEM) for the following:
-- Low Back Disorders Guideline (ACOEM March 7, 2019)
-- Introduction to the Workplace Mental Health Guideline (ACOEM March 13, 2019)
The proposed evidence-based updates to the MTUS regulations are exempt from Labor Code sections 5307.3 and 5307.4 and the rulemaking provisions of the Administrative Procedure Act. However, DWC is required under Labor Code section 5307.27 to have a 30-day public comment period, hold a public hearing, respond to all the comments received during the public comment period and publish the order adopting the updates online ...
A coalition of influential California business groups says it will support a bill that would codify a California Supreme Court decision that placed strict limits on classifying workers as independent contractors - if the legislation includes additional exemptions for certain professions.
"We respectfully SUPPORT if AB 5 is further AMENDED to provide a more progressive and holistic approach that fit today’s modern workforce," the coalition stated in letters to the bill’s author and the Assembly Labor committee submitted Monday afternoon.
The letters - signed by California Chamber of Commerce, California Retailers Association and California Building Industry Association, among others - ask for broader exemptions for professionals beyond those already agreed to for doctors and insurance agents.
The coalition also seeks a broader exemption for workers "who prefer to control their own schedule," including consultants, travel agents, and truck, taxi and "gig economy' drivers; and exempting short-term projects and business-to-business contracts.
The groups’ new position drew cautious praise from the bill’s author and supporters. "It’s a step forward," said the bill’s author, Asm. Lorena Gonzalez (D-San Diego). "I’m glad they’re not opposing it." But Gonzalez called the proposed amendments "too broad."
"They can’t actually think I would agree to those things," she said, adding that she will continue "to work industry-by-industry to find appropriate situations" for additional amendments and exemptions.
Gonzalez named hairdressers and real estate agents as industries she’s open to including and added that she is "interested but not sold on short-term projects."
The California Supreme Court issued the ruling - commonly referred to as the "Dynamex decision" - a year ago. It stemmed from a case brought by delivery drivers who believed the company Dynamex misclassified them as independent contractors instead of employees.
Labor groups hailed the decision as a victory that would extend benefits and protections to more workers. Classifying workers as employees requires employers to pay for unemployment insurance, family leave and workers’ compensation, among other benefits and protections.
The "support-if-amended" position demonstrates the tightrope the Chamber and business groups must walk in the Dynamex debate. Employers argue the current version of the bill would "not only (hurt) the business model of a broad swath of industries and billions of venture capital dollars that are increasingly invested in businesses, but also (hinder) California as a national leader in the innovation economy."
...
"We respectfully SUPPORT if AB 5 is further AMENDED to provide a more progressive and holistic approach that fit today’s modern workforce," the coalition stated in letters to the bill’s author and the Assembly Labor committee submitted Monday afternoon.
The letters - signed by California Chamber of Commerce, California Retailers Association and California Building Industry Association, among others - ask for broader exemptions for professionals beyond those already agreed to for doctors and insurance agents.
The coalition also seeks a broader exemption for workers "who prefer to control their own schedule," including consultants, travel agents, and truck, taxi and "gig economy' drivers; and exempting short-term projects and business-to-business contracts.
The groups’ new position drew cautious praise from the bill’s author and supporters. "It’s a step forward," said the bill’s author, Asm. Lorena Gonzalez (D-San Diego). "I’m glad they’re not opposing it." But Gonzalez called the proposed amendments "too broad."
"They can’t actually think I would agree to those things," she said, adding that she will continue "to work industry-by-industry to find appropriate situations" for additional amendments and exemptions.
Gonzalez named hairdressers and real estate agents as industries she’s open to including and added that she is "interested but not sold on short-term projects."
The California Supreme Court issued the ruling - commonly referred to as the "Dynamex decision" - a year ago. It stemmed from a case brought by delivery drivers who believed the company Dynamex misclassified them as independent contractors instead of employees.
Labor groups hailed the decision as a victory that would extend benefits and protections to more workers. Classifying workers as employees requires employers to pay for unemployment insurance, family leave and workers’ compensation, among other benefits and protections.
The "support-if-amended" position demonstrates the tightrope the Chamber and business groups must walk in the Dynamex debate. Employers argue the current version of the bill would "not only (hurt) the business model of a broad swath of industries and billions of venture capital dollars that are increasingly invested in businesses, but also (hinder) California as a national leader in the innovation economy."
...
The Travelers Companies, Inc. reported an almost 40 percent reduction in the use of opioids among the injured construction workers it has helped, thanks to a combination of its Early Severity Predictor® model and its comprehensive pharmacy management program.
The Early Severity Predictor is the company’s proprietary predictive model that helps forecast which injured employees are at higher risk of developing chronic pain, while the pharmacy management program monitors drug interactions, excessive dosing and abuse patterns to reduce the risk of opioid dependency.
Construction sites contain many health and safety risks for workers, with strains, sprains, broken bones and head traumas among the most common employee injuries. All of these can lead to chronic pain, a condition that is often treated with highly addictive opioids. In fact, roughly half of all workers compensation claims related to the construction industry that are submitted to Travelers involve opioid prescriptions.
"The opioid epidemic is having a profound effect on our society, and the crisis is especially concerning for the construction industry, where the work can be physically demanding," said Rick Keegan, President of Construction at Travelers. "Identifying safe and effective alternatives to treat injuries and prevent chronic pain will help injured employees avoid the risks associated with opioids while helping our customers better manage the related medical costs."
Travelers’ nurses and Claim professionals work closely with at-risk injured employees identified by the Early Severity Predictor model, and their physicians, to develop an aggressive, sports-medicine-like treatment regimen, which often includes physical therapy and other interventions to prevent acute pain from becoming chronic. This approach is particularly significant for the construction industry, where Travelers claim data show that injured workers who suffer from chronic pain can be out of work for as much as 50 percent longer than those in other industries.
"We are committed to using our deep domain expertise, and our industry-leading data and analytics, to help address the causes of chronic pain," said Rich Ives, Vice President of Workers Compensation Claim at Travelers. "We’re finding new ways to curb prescription opioid abuse while getting injured workers the care they need to return to work as soon as is medically appropriate." ...
The Early Severity Predictor is the company’s proprietary predictive model that helps forecast which injured employees are at higher risk of developing chronic pain, while the pharmacy management program monitors drug interactions, excessive dosing and abuse patterns to reduce the risk of opioid dependency.
Construction sites contain many health and safety risks for workers, with strains, sprains, broken bones and head traumas among the most common employee injuries. All of these can lead to chronic pain, a condition that is often treated with highly addictive opioids. In fact, roughly half of all workers compensation claims related to the construction industry that are submitted to Travelers involve opioid prescriptions.
"The opioid epidemic is having a profound effect on our society, and the crisis is especially concerning for the construction industry, where the work can be physically demanding," said Rick Keegan, President of Construction at Travelers. "Identifying safe and effective alternatives to treat injuries and prevent chronic pain will help injured employees avoid the risks associated with opioids while helping our customers better manage the related medical costs."
Travelers’ nurses and Claim professionals work closely with at-risk injured employees identified by the Early Severity Predictor model, and their physicians, to develop an aggressive, sports-medicine-like treatment regimen, which often includes physical therapy and other interventions to prevent acute pain from becoming chronic. This approach is particularly significant for the construction industry, where Travelers claim data show that injured workers who suffer from chronic pain can be out of work for as much as 50 percent longer than those in other industries.
"We are committed to using our deep domain expertise, and our industry-leading data and analytics, to help address the causes of chronic pain," said Rich Ives, Vice President of Workers Compensation Claim at Travelers. "We’re finding new ways to curb prescription opioid abuse while getting injured workers the care they need to return to work as soon as is medically appropriate." ...
Purdue Pharma L.P. is a privately held pharmaceutical company owned principally by descendants of Mortimer and Raymond Sackler. The company is the target of the Opioid litigation stampede.
In 2007 it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges. Purdue continues to market and sell opioids
Purdue Pharma was founded in 1892. In 1952, the company was sold to two other medical doctors, Raymond and Mortimer Sackler. OxyContin, was introduced by the company in 1995. Under a marketing strategy that Arthur Sackler had pioneered decades earlier, the company aggressively pressed doctors to prescribe the drug, wooing them with free trips to pain-management seminars and paid speaking engagements. Sales soared.
OxyContin became a blockbuster drug. Purdue had increased its earnings from a few billion in 2007 to US$31 billion by 2016. That had increased to US$35 billion by 2017. According to a 2017 article in The New Yorker, Purdue Pharma is "owned by one of America's richest families, with a collective net worth of thirteen billion dollars".
Perhaps in response to rumors that Purdue is considering filing for bankruptcy protection as a strategy to limit its damages, the Massachusetts Attorney General Maura Healey’s lawsuit filed against the company in June in Suffolk County Superior Court, was revised earlier this year to include new allegations. The suit is now the first by a state to try to attempt to hold Sackler family members personally responsible for contributing to the opioid epidemic.
Healey’s complaint cites records to argue that family members, including Purdue’s former President Richard Sackler, personally directed deceptive opioid marketing while making $4.2 billion from Purdue from 2008 to 2016.
They did so even after Purdue and three executives in 2007 pleaded guilty to federal charges related to the misbranding of OxyContin and agreed to pay a total of $634.5 million in penalties, the lawsuit said.
But in their motion, the Sacklers said nothing in the complaint supports allegations they personally took part in efforts to mislead doctors and the public about the benefits and addictive risks of opioids.
They said their role was limited to that of typical corporate board members who participated in "routine" votes to ratify the management’s staffing and budget proposals.
"Not a single document shows an individual director engaging in any unlawful conduct regarding the sale of prescription opioids or ordering anyone else to do so," the Sacklers’ lawyers wrote.
Healey, in a statement, called the motion "an attempt to avoid accountability." ...
In 2007 it paid out one of the largest fines ever levied against a pharmaceutical firm for mislabeling its product OxyContin, and three executives were found guilty of criminal charges. Purdue continues to market and sell opioids
Purdue Pharma was founded in 1892. In 1952, the company was sold to two other medical doctors, Raymond and Mortimer Sackler. OxyContin, was introduced by the company in 1995. Under a marketing strategy that Arthur Sackler had pioneered decades earlier, the company aggressively pressed doctors to prescribe the drug, wooing them with free trips to pain-management seminars and paid speaking engagements. Sales soared.
OxyContin became a blockbuster drug. Purdue had increased its earnings from a few billion in 2007 to US$31 billion by 2016. That had increased to US$35 billion by 2017. According to a 2017 article in The New Yorker, Purdue Pharma is "owned by one of America's richest families, with a collective net worth of thirteen billion dollars".
Perhaps in response to rumors that Purdue is considering filing for bankruptcy protection as a strategy to limit its damages, the Massachusetts Attorney General Maura Healey’s lawsuit filed against the company in June in Suffolk County Superior Court, was revised earlier this year to include new allegations. The suit is now the first by a state to try to attempt to hold Sackler family members personally responsible for contributing to the opioid epidemic.
Healey’s complaint cites records to argue that family members, including Purdue’s former President Richard Sackler, personally directed deceptive opioid marketing while making $4.2 billion from Purdue from 2008 to 2016.
They did so even after Purdue and three executives in 2007 pleaded guilty to federal charges related to the misbranding of OxyContin and agreed to pay a total of $634.5 million in penalties, the lawsuit said.
But in their motion, the Sacklers said nothing in the complaint supports allegations they personally took part in efforts to mislead doctors and the public about the benefits and addictive risks of opioids.
They said their role was limited to that of typical corporate board members who participated in "routine" votes to ratify the management’s staffing and budget proposals.
"Not a single document shows an individual director engaging in any unlawful conduct regarding the sale of prescription opioids or ordering anyone else to do so," the Sacklers’ lawyers wrote.
Healey, in a statement, called the motion "an attempt to avoid accountability." ...
Several weeks ago, the Office of Administrative Law (OAL) approved the Fair Employment and Housing Council’s (FEHC) changes to the Family Care and Medical Leave (CFRA Leave) and Pregnancy Disability notice (now called Family Care and Medical Leave and Pregnancy Disability Leave), adding information about the New Parent Leave Act (NPLA).
The changes are now specified in Title 2, California Code of Regulations starting at section 11087.
California employers covered by the California Family Rights Act (CFRA) and the NPLA are required to post this new revised notice starting April 1, 2019.
The California Chamber of Commerce summary says that the NPLA is a narrowly tailored California leave law that took effect last year. Both the CFRA and NPLA provide 12 weeks of unpaid, job-protected leave to bond with a newborn or a child placed with the employee for adoption or foster care.
The CFRA applies to employers who have 50 or more employees and the NPLA applies to employers who have less than 50 employees but have at least 20 employees.
While the CFRA provides additional medical leave, the NPLA does not and is limited to baby bonding leave.
Effective April 1, 2019, employers with 20 to 49 employees will need to post the Family Care and Medical Leave and Pregnancy Disability Leave notice in their workplace, and employers with 50 or more employees will need to replace their existing notice with the new version.
The CalChamber all-in-one California and Federal Labor Law poster (available at calchamberstore.com) includes the 18 state and federal employment notices every California employer must post, including the Family Care and Medical Leave and Pregnancy Disability Leave notice ...
The changes are now specified in Title 2, California Code of Regulations starting at section 11087.
California employers covered by the California Family Rights Act (CFRA) and the NPLA are required to post this new revised notice starting April 1, 2019.
The California Chamber of Commerce summary says that the NPLA is a narrowly tailored California leave law that took effect last year. Both the CFRA and NPLA provide 12 weeks of unpaid, job-protected leave to bond with a newborn or a child placed with the employee for adoption or foster care.
The CFRA applies to employers who have 50 or more employees and the NPLA applies to employers who have less than 50 employees but have at least 20 employees.
While the CFRA provides additional medical leave, the NPLA does not and is limited to baby bonding leave.
Effective April 1, 2019, employers with 20 to 49 employees will need to post the Family Care and Medical Leave and Pregnancy Disability Leave notice in their workplace, and employers with 50 or more employees will need to replace their existing notice with the new version.
The CalChamber all-in-one California and Federal Labor Law poster (available at calchamberstore.com) includes the 18 state and federal employment notices every California employer must post, including the Family Care and Medical Leave and Pregnancy Disability Leave notice ...
Jocelyn Bowen injured her neck and right shoulder while working for the County of San Bernardino. Since at least March 9, 2015, she was prescribed, and she used, Norco to control her symptoms of pain.
On November 23, 2015, IMR issued a final determination letter finding, that the prescribed Norco was medically necessary and appropriate. The rationale was that she "rates the pain 8-9 out of 10 on pain scale without medications and 4-5 out of 10 on the pain scale with medications . .. . The injured worker reports functional improvement and improvement in pain with medications. She notes improvement in activities of daily living (ADL) as well as increased ability to reach, lift, grab and hold as a result of her medication usage."
The following month, the PTP again prescribed Norco based upon the same clinical observations. UR rejected the December RFA which was again appealed to IMR.The second IMR reviewer was a family practice physician, and upheld the UR denial.
The first November 23, 2015 IMR final determination letter was not included, in the information given to the second IMR reviewer, and there is no indication that the second IMR reviewer considered it. The second reviewer noted that "Although the physician noted an improvement in the level of function with medication use, there was no documentation of any specific objective functional improvements with the use of Norco."
Applicant timely appealed the second IMR determination pursuant to L.C. section 4610.6(h). The WCJ granted the appeal, and found that the IMR determination contained plainly erroneous findings and was without or in excess of the powers of the AD, and rescinded the IMR determination, and ordered the dispute to a new IMR reviewer in the specialty of orthopedic surgery, pain management, and/or physical medicine and rehabilitation. The WCJ also indicated that the new IMR reviewer should review the previous IMR determination.
The former acting Administrative Director objected to the WCJ's instruction that the new IMR reviewer should review a previous IMR determination approving the prescription for Norco, arguing that review of a prior IMR final determination may detract from the independence of the new review. The AD agreed that the IMR reviewer should be in a specialty more appropriately matched to applicant's diagnosis, and submitted the matter for a new IMR determination.
The WCAB rejected the limits placed by the Administrative Director and affirmed the WCJ in the panel decision of Bowen v the County of San Bernardino.
The Court of Appeal held that IMR determinations are subject to meaningful review, even if the Appeals Board cannot change medical necessity determinations, noting that "[t]he Board's authority to review an IMR determination includes the authority to determine whether it was adopted without authority or based on a plainly erroneous fact that is not a matter of expert opinion." (Stevens v. Workers' Comp. Appeals Bd. (2015) 241 Cal.App.4th 1074, 1100.)
The record reflects that the IMR reviewer did not review all the documents submitted. The record does not reflect the reason these documents were not included in the IMR review or what information was contained in them. It is unknown whether the IMR organization failed to provide these records to the reviewer, or whether the physician reviewer ignored or overlooked them.
As part of the new IMR, applicant may re-submit the November 23, 2015 IMR final determination and all of the PTP reports to the IMR reviewer ...
On November 23, 2015, IMR issued a final determination letter finding, that the prescribed Norco was medically necessary and appropriate. The rationale was that she "rates the pain 8-9 out of 10 on pain scale without medications and 4-5 out of 10 on the pain scale with medications . .. . The injured worker reports functional improvement and improvement in pain with medications. She notes improvement in activities of daily living (ADL) as well as increased ability to reach, lift, grab and hold as a result of her medication usage."
The following month, the PTP again prescribed Norco based upon the same clinical observations. UR rejected the December RFA which was again appealed to IMR.The second IMR reviewer was a family practice physician, and upheld the UR denial.
The first November 23, 2015 IMR final determination letter was not included, in the information given to the second IMR reviewer, and there is no indication that the second IMR reviewer considered it. The second reviewer noted that "Although the physician noted an improvement in the level of function with medication use, there was no documentation of any specific objective functional improvements with the use of Norco."
Applicant timely appealed the second IMR determination pursuant to L.C. section 4610.6(h). The WCJ granted the appeal, and found that the IMR determination contained plainly erroneous findings and was without or in excess of the powers of the AD, and rescinded the IMR determination, and ordered the dispute to a new IMR reviewer in the specialty of orthopedic surgery, pain management, and/or physical medicine and rehabilitation. The WCJ also indicated that the new IMR reviewer should review the previous IMR determination.
The former acting Administrative Director objected to the WCJ's instruction that the new IMR reviewer should review a previous IMR determination approving the prescription for Norco, arguing that review of a prior IMR final determination may detract from the independence of the new review. The AD agreed that the IMR reviewer should be in a specialty more appropriately matched to applicant's diagnosis, and submitted the matter for a new IMR determination.
The WCAB rejected the limits placed by the Administrative Director and affirmed the WCJ in the panel decision of Bowen v the County of San Bernardino.
The Court of Appeal held that IMR determinations are subject to meaningful review, even if the Appeals Board cannot change medical necessity determinations, noting that "[t]he Board's authority to review an IMR determination includes the authority to determine whether it was adopted without authority or based on a plainly erroneous fact that is not a matter of expert opinion." (Stevens v. Workers' Comp. Appeals Bd. (2015) 241 Cal.App.4th 1074, 1100.)
The record reflects that the IMR reviewer did not review all the documents submitted. The record does not reflect the reason these documents were not included in the IMR review or what information was contained in them. It is unknown whether the IMR organization failed to provide these records to the reviewer, or whether the physician reviewer ignored or overlooked them.
As part of the new IMR, applicant may re-submit the November 23, 2015 IMR final determination and all of the PTP reports to the IMR reviewer ...
It was a busy month for the Monetrey County District attorney who reports two convictions for uninsured employers in March.
The District Attorney announced that Vanessa Lizeth Aguilar, a 37-yearold Soledad resident who owns a cannabis delivery service in Salinas, was sentenced to 3 years’ probation for failing to carry workers’ compensation insurance. Ms. Aguilarto was ordered pay a $3,500 fine and she faces up to 1-year in county jail and additional fines if she violates her probation.
Ms. Aguilar owns Golden Essentials Delivery. Her company, which has 8 employees, began doing business, under state and city licensing, on January 1, 2018. Since she has employees, California law requires that Ms. Aguilar maintain workers’ compensation insurance.
While she initially did have workers’ compensation insurance, her policy with the State Compensation Insurance Fund expired on March 26, 2018.
On June 27, 2018, Monterey County District Attorney Investigators asked Ms. Aguilar to provide verification that she had workers’ compensation insurance.
She conceded that she did not have a policy, which is a misdemeanor under California Labor Code section 3700.5.
The District Attorney filed criminal charges on October 30, 2018. The case was investigated by District Attorney Investigators George Costaand Steve Guidi.
Also in March, the Monterey County District attorney announced that Jorge Luis Calvo Padilla, a 46-year old Seaside resident, was sentenced to 3 years’ probation and ordered to pay a $1,000 fine for failing to carry workers’ compensation insurance.
Mr. Padilla faces up to 1-year in county jail and additional fines if he violates his probation.
On June 18, 2018, the Contractor State Licensing Board ('CSLB') investigated a report of unlicensed construction at a property located at Camino Del Monte 4 NW of San Carlos in Carmel by the Seas.
At the property, CSLB investigators observed 2 men constructing a wooden deck behind the residence. Mr. Padilla was identified as the contractor on the project and admitted that he was not a licensed contractor. In addition, Mr. Padilla admitted that he had hired a worker to help with the deck.
On October 30, 2018, the Monterey County District Attorney’s Workers Compensation Fraud Unit charged Mr. Padilla with unlicensed contracting in violation of Business & Professions Code section 7028(a) and not having workers ‘compensation insurance, a violation of Labor Code section 3700.5.
Both offenses are misdemeanors. The case was investigated by the Contractor State Licensing Board ...
The District Attorney announced that Vanessa Lizeth Aguilar, a 37-yearold Soledad resident who owns a cannabis delivery service in Salinas, was sentenced to 3 years’ probation for failing to carry workers’ compensation insurance. Ms. Aguilarto was ordered pay a $3,500 fine and she faces up to 1-year in county jail and additional fines if she violates her probation.
Ms. Aguilar owns Golden Essentials Delivery. Her company, which has 8 employees, began doing business, under state and city licensing, on January 1, 2018. Since she has employees, California law requires that Ms. Aguilar maintain workers’ compensation insurance.
While she initially did have workers’ compensation insurance, her policy with the State Compensation Insurance Fund expired on March 26, 2018.
On June 27, 2018, Monterey County District Attorney Investigators asked Ms. Aguilar to provide verification that she had workers’ compensation insurance.
She conceded that she did not have a policy, which is a misdemeanor under California Labor Code section 3700.5.
The District Attorney filed criminal charges on October 30, 2018. The case was investigated by District Attorney Investigators George Costaand Steve Guidi.
Also in March, the Monterey County District attorney announced that Jorge Luis Calvo Padilla, a 46-year old Seaside resident, was sentenced to 3 years’ probation and ordered to pay a $1,000 fine for failing to carry workers’ compensation insurance.
Mr. Padilla faces up to 1-year in county jail and additional fines if he violates his probation.
On June 18, 2018, the Contractor State Licensing Board ('CSLB') investigated a report of unlicensed construction at a property located at Camino Del Monte 4 NW of San Carlos in Carmel by the Seas.
At the property, CSLB investigators observed 2 men constructing a wooden deck behind the residence. Mr. Padilla was identified as the contractor on the project and admitted that he was not a licensed contractor. In addition, Mr. Padilla admitted that he had hired a worker to help with the deck.
On October 30, 2018, the Monterey County District Attorney’s Workers Compensation Fraud Unit charged Mr. Padilla with unlicensed contracting in violation of Business & Professions Code section 7028(a) and not having workers ‘compensation insurance, a violation of Labor Code section 3700.5.
Both offenses are misdemeanors. The case was investigated by the Contractor State Licensing Board ...
Fresenius Medical Care operates more than 40 production sites on all continents. Its largest plants in terms of production output are in the U.S. (Ogden, Utah, and Concord, California), Germany (Schweinfurt and St. Wendel), and Japan (Buzen).
A division of Fresenius Medical Care North America (FMCNA), Fresenius Kidney Care is the worldwide leader in the treatment of renal disease and an innovative leader in kidney disease research. It claims to serve over 190,000 patients in over 2,400 facilities nationwide.
In 2012, Fresenius acquired Liberty Dialysis Holdings, in a deal which entailed the sale of its outpatient dialysis clinics in 43 local markets within the U.S.
In 2013, Fresenius Medical Care NA acquired Shiel Medical Laboratory Inc, expanding services to New York City metro area. In September 2017 the company announced the divestment of the business of Shiel Medical Laboratory, Inc. to Quest Diagnostics, Inc.
Fresenius Medical Care has just agreed to pay approximately $231 million to resolve investigations by the DOJ and the SEC into violations of the Foreign Corrupt Practices Act (FCPA) in connection with Fresenius’s participation in various corrupt schemes to obtain business in multiple foreign countries.
Fresenius admitted it paid bribes to publicly employed health and/or government officials to obtain or retain business in Angola and Saudi Arabia. as well as in Morocco, Spain, Turkey and countries in West Africa,
"Fresenius doled out millions of dollars in bribes across the globe to gain a competitive advantage in the medical services industry, profiting to the tune of over $140 million," said Assistant Attorney General Benczkowski.
In total, Fresenius admitted to earning more than $140 million in profits from the corrupt schemes.
To resolve the case, Fresenius entered into a nonprosecution agreement (NPA) with the Department and agreed to pay a total criminal penalty of $84,715,273. As part of the NPA, Fresenius also agreed to continue to cooperate with the Department’s investigation, enhance its compliance program, implement rigorous internal controls and retain an independent corporate compliance monitor for at least two years.
Fresenius settled a related FCPA matter with the U.S. Securities and Exchange Commission (SEC), and will pay $147 million in disgorgement and prejudgment interest to the SEC, which the Department credited in its resolution, bringing the total amount paid by Fresenius to over $231 million.
This case is being investigated by the FBI’s International Corruption Squad in New York and the FBI’s Boston Field Office. Trial Attorneys Paul A. Hayden and Sonali D. Patel of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Jordi de Llano of the District of Massachusetts are prosecuting the case ...
A division of Fresenius Medical Care North America (FMCNA), Fresenius Kidney Care is the worldwide leader in the treatment of renal disease and an innovative leader in kidney disease research. It claims to serve over 190,000 patients in over 2,400 facilities nationwide.
In 2012, Fresenius acquired Liberty Dialysis Holdings, in a deal which entailed the sale of its outpatient dialysis clinics in 43 local markets within the U.S.
In 2013, Fresenius Medical Care NA acquired Shiel Medical Laboratory Inc, expanding services to New York City metro area. In September 2017 the company announced the divestment of the business of Shiel Medical Laboratory, Inc. to Quest Diagnostics, Inc.
Fresenius Medical Care has just agreed to pay approximately $231 million to resolve investigations by the DOJ and the SEC into violations of the Foreign Corrupt Practices Act (FCPA) in connection with Fresenius’s participation in various corrupt schemes to obtain business in multiple foreign countries.
Fresenius admitted it paid bribes to publicly employed health and/or government officials to obtain or retain business in Angola and Saudi Arabia. as well as in Morocco, Spain, Turkey and countries in West Africa,
"Fresenius doled out millions of dollars in bribes across the globe to gain a competitive advantage in the medical services industry, profiting to the tune of over $140 million," said Assistant Attorney General Benczkowski.
In total, Fresenius admitted to earning more than $140 million in profits from the corrupt schemes.
To resolve the case, Fresenius entered into a nonprosecution agreement (NPA) with the Department and agreed to pay a total criminal penalty of $84,715,273. As part of the NPA, Fresenius also agreed to continue to cooperate with the Department’s investigation, enhance its compliance program, implement rigorous internal controls and retain an independent corporate compliance monitor for at least two years.
Fresenius settled a related FCPA matter with the U.S. Securities and Exchange Commission (SEC), and will pay $147 million in disgorgement and prejudgment interest to the SEC, which the Department credited in its resolution, bringing the total amount paid by Fresenius to over $231 million.
This case is being investigated by the FBI’s International Corruption Squad in New York and the FBI’s Boston Field Office. Trial Attorneys Paul A. Hayden and Sonali D. Patel of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Jordi de Llano of the District of Massachusetts are prosecuting the case ...
The New Mexico Medical Cannabis Advisory Board voted 4-0 to reaffirm its support for adding opioid-use disorder to a long list of qualifying conditions for medical marijuana that currently includes cancer, chronic pain and post-traumatic stress disorder.
Lujan Grisham campaigned for office last year as an advocate for adding opioid dependency as a qualifying condition for legal access to cannabis. Newly appointed state Health Secretary Kathyleen Kunkel has discretion over whether to add new qualifying conditions for medical marijuana use.
Kunkel's predecessor under Republican Gov. Susana Martinez said it wasn't clear whether cannabis would be a safe or effective response to opiate dependence and that research was lacking.
Commenting on her support for the measure, Medical Cannabis Advisory Board Chairwoman Laura Brown cited the annual death toll from opioid related overdoses in New Mexico - estimated at 305 people in 2017 - and indications that marijuana reduces reliance on opioids.
"This is harm reduction, people need to be reminded," said Brown, who added that she met with Kunkel this week at the secretary's invitation.
About 70,000 patients are enrolled in New Mexico's medical marijuana program. The program was initiated in 2007 and has grown as the list of qualifying conditions has expanded.
Brown said there is no strict deadline for the Health Department to decide whether to add opioid use to the list of qualifying conditions for marijuana access.
Health Department spokesman David Morgan said agency's secretary also is considering advisory board recommendations to expand medical marijuana access to patients diagnosed with autism and those suffering from degenerative neurological disorders including Alzheimer's disease.
The advisory board on Friday separately recommended expanding the medical marijuana program to people suffering from diagnosable problems with alcohol, stimulants, hallucinogens and a variety of prescription drugs.
A petition was rejected to automatically provide medical marijuana access to people aged 65 and over ...
Lujan Grisham campaigned for office last year as an advocate for adding opioid dependency as a qualifying condition for legal access to cannabis. Newly appointed state Health Secretary Kathyleen Kunkel has discretion over whether to add new qualifying conditions for medical marijuana use.
Kunkel's predecessor under Republican Gov. Susana Martinez said it wasn't clear whether cannabis would be a safe or effective response to opiate dependence and that research was lacking.
Commenting on her support for the measure, Medical Cannabis Advisory Board Chairwoman Laura Brown cited the annual death toll from opioid related overdoses in New Mexico - estimated at 305 people in 2017 - and indications that marijuana reduces reliance on opioids.
"This is harm reduction, people need to be reminded," said Brown, who added that she met with Kunkel this week at the secretary's invitation.
About 70,000 patients are enrolled in New Mexico's medical marijuana program. The program was initiated in 2007 and has grown as the list of qualifying conditions has expanded.
Brown said there is no strict deadline for the Health Department to decide whether to add opioid use to the list of qualifying conditions for marijuana access.
Health Department spokesman David Morgan said agency's secretary also is considering advisory board recommendations to expand medical marijuana access to patients diagnosed with autism and those suffering from degenerative neurological disorders including Alzheimer's disease.
The advisory board on Friday separately recommended expanding the medical marijuana program to people suffering from diagnosable problems with alcohol, stimulants, hallucinogens and a variety of prescription drugs.
A petition was rejected to automatically provide medical marijuana access to people aged 65 and over ...
Cal/OSHA has issued serious health and safety citations to Underground Construction Co., Inc. of Benicia after two of its employees contracted Valley Fever. The workers were exposed to the fungal disease while using hand tools to dig trenches in Kings, Fresno and Merced counties—areas where the soil is known to contain harmful spores that cause the infection.
Cal/OSHA was notified in September 2018 that the employees were hospitalized after being diagnosed with Valley Fever, also known as Coccidioidomycosis. Symptoms of the disease are similar to the flu and include fatigue, shortness of breath and fever. Severe cases can cause serious lung problems.
The workers were tasked with digging trenches up to 5½ feet deep to allow access to gas pipelines for maintenance. Dust was not controlled, and the workers did not wear any respiratory protection. Exposure to the disease could have occurred in any one of the three counties where the fungal spores are known to be endemic.
Cal/OSHA’s investigation found that Underground Construction Co., Inc. did not evaluate the hazard of performing digging work in areas known to contain the coccidioides fungal spores. The employer did not suppress or control harmful dusts and failed to provide employees with respiratory protection. Cal/OSHA issued three citations to the employer with $27,000 in proposed penalties.
Since 2017, Cal/OSHA has cited 12 businesses for work-related Valley Fever.
Valley Fever is caused by a microscopic fungus known as Coccidioides immitis, which lives in the top two to 12 inches of soil in many parts of the state. When soil is disturbed by digging, driving or high winds, fungal spores can become airborne and may be inhaled by workers who are not protected. While the fungal spores are most likely to be present in the soils of the Central Valley, they may also be present in other areas of California. Cal/OSHA’s Valley Fever informational page provides detailed information including resources for workers and employers.
Tips for reducing the risk of Valley Fever exposure include:
-- Determine if a worksite is in an area where fungal spores are likely to be present.
-- Adopt site plans and work practices that minimize the disturbance of soil and maximize ground cover.
-- Use water, appropriate soil stabilizers, and/or re-vegetation to reduce airborne dust.
-- Limit workers’ exposure to outdoor dust in disease-endemic areas by (1) providing air-conditioned cabs for vehicles that generate dust and making sure workers keep windows and vents closed, (2) suspending work during heavy winds, and (3) providing sleeping quarters, if applicable, away from sources of dust.
-- When exposure to dust is unavoidable, provide approved respiratory protection to filter particles.
- Train supervisors and workers in how to recognize symptoms of Valley Fever and minimize exposure. Cal/OSHA helps protect workers from health and safety hazards on the job in almost every workplace in
California. Cal/OSHA’s Consultation Services Branch provides free and voluntary assistance to employers to improve their health and safety programs. Employers should call (800) 963-9424 for assistance from Cal/OSHA Consultation Services
...
Cal/OSHA was notified in September 2018 that the employees were hospitalized after being diagnosed with Valley Fever, also known as Coccidioidomycosis. Symptoms of the disease are similar to the flu and include fatigue, shortness of breath and fever. Severe cases can cause serious lung problems.
The workers were tasked with digging trenches up to 5½ feet deep to allow access to gas pipelines for maintenance. Dust was not controlled, and the workers did not wear any respiratory protection. Exposure to the disease could have occurred in any one of the three counties where the fungal spores are known to be endemic.
Cal/OSHA’s investigation found that Underground Construction Co., Inc. did not evaluate the hazard of performing digging work in areas known to contain the coccidioides fungal spores. The employer did not suppress or control harmful dusts and failed to provide employees with respiratory protection. Cal/OSHA issued three citations to the employer with $27,000 in proposed penalties.
Since 2017, Cal/OSHA has cited 12 businesses for work-related Valley Fever.
Valley Fever is caused by a microscopic fungus known as Coccidioides immitis, which lives in the top two to 12 inches of soil in many parts of the state. When soil is disturbed by digging, driving or high winds, fungal spores can become airborne and may be inhaled by workers who are not protected. While the fungal spores are most likely to be present in the soils of the Central Valley, they may also be present in other areas of California. Cal/OSHA’s Valley Fever informational page provides detailed information including resources for workers and employers.
Tips for reducing the risk of Valley Fever exposure include:
-- Determine if a worksite is in an area where fungal spores are likely to be present.
-- Adopt site plans and work practices that minimize the disturbance of soil and maximize ground cover.
-- Use water, appropriate soil stabilizers, and/or re-vegetation to reduce airborne dust.
-- Limit workers’ exposure to outdoor dust in disease-endemic areas by (1) providing air-conditioned cabs for vehicles that generate dust and making sure workers keep windows and vents closed, (2) suspending work during heavy winds, and (3) providing sleeping quarters, if applicable, away from sources of dust.
-- When exposure to dust is unavoidable, provide approved respiratory protection to filter particles.
- Train supervisors and workers in how to recognize symptoms of Valley Fever and minimize exposure. Cal/OSHA helps protect workers from health and safety hazards on the job in almost every workplace in
California. Cal/OSHA’s Consultation Services Branch provides free and voluntary assistance to employers to improve their health and safety programs. Employers should call (800) 963-9424 for assistance from Cal/OSHA Consultation Services
...
The Workers Compensation Research Institute (WCRI) has released an online version of its 2019 Annual Report. This report was distributed in hard copy at the Institute’s recently held annual conference.
WCRI’s 2019 Annual Report takes a comprehensive look at all of the Institute’s activities in 2018. It begins with a letter from WCRI CEO John Ruser, who compares the Institute now with 35 years ago. The following are among the information included in the report:
-- Studies published in 2018, as well as a review of some of them
-- Where the research was used and shared
-- Presentations given, including webinars
-- Corporate social responsibility
-- Impact of social media
-- Number of media mentions
-- Interviews with WCRI members
-- List of WCRI’s members and supporters
The report thanks WCRI’s members and friends for their support, which has enabled WCRI to produce independent, credible, and high-quality research on state workers’ compensation systems for 35 years.
"I hope everyone gets a chance to view our annual report. It provides an overview of the research we published last year as well as how that research was used by policymakers and other stakeholders to make more informed decisions," said John Ruser, president and CEO of WCRI ...
WCRI’s 2019 Annual Report takes a comprehensive look at all of the Institute’s activities in 2018. It begins with a letter from WCRI CEO John Ruser, who compares the Institute now with 35 years ago. The following are among the information included in the report:
-- Studies published in 2018, as well as a review of some of them
-- Where the research was used and shared
-- Presentations given, including webinars
-- Corporate social responsibility
-- Impact of social media
-- Number of media mentions
-- Interviews with WCRI members
-- List of WCRI’s members and supporters
The report thanks WCRI’s members and friends for their support, which has enabled WCRI to produce independent, credible, and high-quality research on state workers’ compensation systems for 35 years.
"I hope everyone gets a chance to view our annual report. It provides an overview of the research we published last year as well as how that research was used by policymakers and other stakeholders to make more informed decisions," said John Ruser, president and CEO of WCRI ...
More than 1,000 lawsuits accusing Purdue Pharma and other opioid manufacturers of using deceptive practices to push addictive drugs that led to fatal overdoses are consolidated in an Ohio federal court. One of them, a lesser-known opioid case: Oklahoma v. Purdue Pharma, was scheduled for trial in May in Norman, Oklahoma.
The Oklahoma trial was expected to presage many of the arguments the jury may be presented in the national case set in the fall on 2019, and others being scheduled for trial out of the 1000 or so that are in process.
Business Insurance reported a few weeks ago that Purdue Pharma was exploring filing for bankruptcy to address potentially significant liabilities from the lawsuits.
In an unexpected turn of events, the Oklahoma Attorney General just announced an historic settlement with Purdue Pharma that will establish a nearly $200 million endowment at the Oklahoma State University’s Center for Wellness and Recovery, which will go toward treating the ongoing addiction epidemic nationwide.
The trial against Johnson & Johnson, Teva and the other defendants named in the state’s lawsuit remains on track for May 28.
The endowment provides funding for an entity that will receive the initial $102.5 million that will go to the Oklahoma State University Center for Health Sciences Center for Wellness and Recovery, Oklahoma’s most comprehensive treatment and research center for treating pain and addiction.
Beginning Jan. 1, 2020, the entity will receive an annual $15 million payment over a five year period. During the same five year timeframe, it will receive ongoing contributions of addiction treatment medicine, valued at $20 million.
Oklahoma State University President Burns Hargis, who spoke at the news conference congratulated Attorney General Hunter and his team.
"We extend our congratulations to Oklahoma Attorney General Mike Hunter and the legal team for their foresight to skillfully craft a settlement that will position Oklahoma State University’s Center for Wellness and Recovery to serve as the premiere institution for research, education and treatment for addiction in the United States," President Hargis said.
$12.5 million will go towards providing funds to directly abate and address the opioid epidemic’s effects in Oklahoma’s cities and counties. Purdue will also make a $60 million payment to offset all litigation costs up to this point.
Purdue will not promote opioids in Oklahoma, including employing or contracting with sales representatives to health care providers in Oklahoma.
"We appreciate that Purdue Pharma and its owners chose to work constructively with us to resolve this litigation in a way that will bring to life a new and unique national center with the goal of creating breakthrough innovations in the prevention and treatment of addiction," Attorney General Hunter said ...
The Oklahoma trial was expected to presage many of the arguments the jury may be presented in the national case set in the fall on 2019, and others being scheduled for trial out of the 1000 or so that are in process.
Business Insurance reported a few weeks ago that Purdue Pharma was exploring filing for bankruptcy to address potentially significant liabilities from the lawsuits.
In an unexpected turn of events, the Oklahoma Attorney General just announced an historic settlement with Purdue Pharma that will establish a nearly $200 million endowment at the Oklahoma State University’s Center for Wellness and Recovery, which will go toward treating the ongoing addiction epidemic nationwide.
The trial against Johnson & Johnson, Teva and the other defendants named in the state’s lawsuit remains on track for May 28.
The endowment provides funding for an entity that will receive the initial $102.5 million that will go to the Oklahoma State University Center for Health Sciences Center for Wellness and Recovery, Oklahoma’s most comprehensive treatment and research center for treating pain and addiction.
Beginning Jan. 1, 2020, the entity will receive an annual $15 million payment over a five year period. During the same five year timeframe, it will receive ongoing contributions of addiction treatment medicine, valued at $20 million.
Oklahoma State University President Burns Hargis, who spoke at the news conference congratulated Attorney General Hunter and his team.
"We extend our congratulations to Oklahoma Attorney General Mike Hunter and the legal team for their foresight to skillfully craft a settlement that will position Oklahoma State University’s Center for Wellness and Recovery to serve as the premiere institution for research, education and treatment for addiction in the United States," President Hargis said.
$12.5 million will go towards providing funds to directly abate and address the opioid epidemic’s effects in Oklahoma’s cities and counties. Purdue will also make a $60 million payment to offset all litigation costs up to this point.
Purdue will not promote opioids in Oklahoma, including employing or contracting with sales representatives to health care providers in Oklahoma.
"We appreciate that Purdue Pharma and its owners chose to work constructively with us to resolve this litigation in a way that will bring to life a new and unique national center with the goal of creating breakthrough innovations in the prevention and treatment of addiction," Attorney General Hunter said ...
The Division of Workers’ Compensation (DWC) has posted an order adjusting the Hospital Outpatient Departments and Ambulatory Surgical Centers section of the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1.
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:
-- The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2019 Addendum A quarterly update
-- The CMS Medicare OPPS April 2019 Addendum B quarterly update
-- The CMS Ambulatory Surgical Center Payment System, April 2019 ASC Approved HCPCS Code and Payment Rates, Column A entitled “HCPCS Code” of “Apr 2019 ASC AA” and Column A entitled “HCPCS Code” of “Apr 2019 ASC EE”
-- Certain sections of the CMS Medicare OPPS April 2019 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V20.1 quarterly update
-- CMS April 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS), Change Request (CR) 11216 (March 15, 2019), Transmittal R4255CP
The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2019 and is posted on the DWC website ...
The Hospital Outpatient Departments and Ambulatory Surgical Centers fee schedule update order adopts the following Centers for Medicare & Medicaid Services (CMS) Medicare changes:
-- The CMS Medicare Hospital Outpatient Prospective Payment System (OPPS) April 2019 Addendum A quarterly update
-- The CMS Medicare OPPS April 2019 Addendum B quarterly update
-- The CMS Ambulatory Surgical Center Payment System, April 2019 ASC Approved HCPCS Code and Payment Rates, Column A entitled “HCPCS Code” of “Apr 2019 ASC AA” and Column A entitled “HCPCS Code” of “Apr 2019 ASC EE”
-- Certain sections of the CMS Medicare OPPS April 2019 Integrated Outpatient Code Editor (I/OCE), IOCE Quarterly Data Files V20.1 quarterly update
-- CMS April 2019 Update of the Hospital Outpatient Prospective Payment System (OPPS), Change Request (CR) 11216 (March 15, 2019), Transmittal R4255CP
The order adopting the OMFS adjustments is effective for services rendered on or after April 1, 2019 and is posted on the DWC website ...
South Bay QME, Venkat Aachi M.D. pleaded guilty to distributing hydrocodone outside the scope of his professional practice and without a legitimate medical need, and to health care fraud. The guilty plea was accepted by the Honorable Edward J. Davila, U.S. District Judge.
The DWC lists Vankat Aachi M.D. as a QME in Physical Medicine and Rehabilitation with offices at 221 E. Hacienda Avenue Suite D , Campbell, CA 95008-6625 and 2324 Montplelier Drive, Suite 2 , San Jose , Ca., 95116-1612
At the time of his arrest, federal prosecutors contended that Aachi submitted to an insurance company in July a false and fraudulent claim for payment for healthcare benefits, items and services.
According to the plea agreement, Aachi, 52, of Saratoga, was a licensed physician in the state of California who operated a pain clinic in San Jose. He maintained a DEA registration number authorizing him to prescribe controlled substances. Aachi admitted that from September 18, 2017, through July 2, 2018, he wrote hydrocodone-acetaminophen prescriptions that were outside the scope of his professional practice and not for a legitimate medical purpose.
The plea agreement describes transactions in which Aachi improperly distributed hydrocodone. For example, in November of 2017, he wrote a prescription enabling a patient to receive 90 hydrocodone-acetaminophen pills. Aachi did not conduct a physical examination of the patient nor discuss the patient’s pain or response to prior medication. Aachi acknowledged that he knew the prescriptions were not for a legitimate medical purpose and that he did not write the prescriptions in the usual course of his professional practice.
Further, Aachi admitted that on July 2, 2018, he falsely submitted to an insurance company a false and fraudulent claim for payment for healthcare benefits, items, and services. Aachi admitted he acted with the intend to defraud the insurance company.
On October 9, 2018, a federal grand jury indicted Aachi and charged him with six counts of distributing drugs outside the scope of professional practice, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C), and one count of health care fraud, in violation of 18 U.S.C. § 1347. Aachi pleaded guilty to one count under each statute.
Aachi remains free on bail pending sentencing. Judge Davila scheduled Aachi’s sentencing hearing for July 1, 2019.
Aachi faces a maximum sentence of 20 years in prison and a fine of $1,000,000 for the illegal distribution of hydrocodone count and 10 years in prison and a $250,000 fine for the health care fraud count.
Additional fines, restitution, and additional periods of supervised release also could be ordered at sentencing. However, any sentence following conviction would be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.
This prosecution is the result of investigations by the DEA, FBI, HHS-OIG, and the BMFEA. Through the BMFEA, the California Department of Justice regularly works with other law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi Cal program against a wide variety of healthcare providers, including doctors and pharmaceutical companies.
This case was investigated and prosecuted by member agencies of the Organized Crime Drug Enforcement Task Force, a focused multi-agency, multi-jurisdictional task force investigating and prosecuting the most significant drug trafficking organizations throughout the United States by leveraging the combined expertise of federal, state, and local law enforcement agencies ...
The DWC lists Vankat Aachi M.D. as a QME in Physical Medicine and Rehabilitation with offices at 221 E. Hacienda Avenue Suite D , Campbell, CA 95008-6625 and 2324 Montplelier Drive, Suite 2 , San Jose , Ca., 95116-1612
At the time of his arrest, federal prosecutors contended that Aachi submitted to an insurance company in July a false and fraudulent claim for payment for healthcare benefits, items and services.
According to the plea agreement, Aachi, 52, of Saratoga, was a licensed physician in the state of California who operated a pain clinic in San Jose. He maintained a DEA registration number authorizing him to prescribe controlled substances. Aachi admitted that from September 18, 2017, through July 2, 2018, he wrote hydrocodone-acetaminophen prescriptions that were outside the scope of his professional practice and not for a legitimate medical purpose.
The plea agreement describes transactions in which Aachi improperly distributed hydrocodone. For example, in November of 2017, he wrote a prescription enabling a patient to receive 90 hydrocodone-acetaminophen pills. Aachi did not conduct a physical examination of the patient nor discuss the patient’s pain or response to prior medication. Aachi acknowledged that he knew the prescriptions were not for a legitimate medical purpose and that he did not write the prescriptions in the usual course of his professional practice.
Further, Aachi admitted that on July 2, 2018, he falsely submitted to an insurance company a false and fraudulent claim for payment for healthcare benefits, items, and services. Aachi admitted he acted with the intend to defraud the insurance company.
On October 9, 2018, a federal grand jury indicted Aachi and charged him with six counts of distributing drugs outside the scope of professional practice, in violation of 21 U.S.C. § 841(a)(1) and (b)(1)(C), and one count of health care fraud, in violation of 18 U.S.C. § 1347. Aachi pleaded guilty to one count under each statute.
Aachi remains free on bail pending sentencing. Judge Davila scheduled Aachi’s sentencing hearing for July 1, 2019.
Aachi faces a maximum sentence of 20 years in prison and a fine of $1,000,000 for the illegal distribution of hydrocodone count and 10 years in prison and a $250,000 fine for the health care fraud count.
Additional fines, restitution, and additional periods of supervised release also could be ordered at sentencing. However, any sentence following conviction would be imposed by the court after consideration of the U.S. Sentencing Guidelines and the federal statute governing the imposition of a sentence, 18 U.S.C. § 3553.
This prosecution is the result of investigations by the DEA, FBI, HHS-OIG, and the BMFEA. Through the BMFEA, the California Department of Justice regularly works with other law enforcement agencies to investigate and prosecute fraud perpetrated on the Medi Cal program against a wide variety of healthcare providers, including doctors and pharmaceutical companies.
This case was investigated and prosecuted by member agencies of the Organized Crime Drug Enforcement Task Force, a focused multi-agency, multi-jurisdictional task force investigating and prosecuting the most significant drug trafficking organizations throughout the United States by leveraging the combined expertise of federal, state, and local law enforcement agencies ...
John Michael "Mike" Herron II, 36, of Stockton, pleaded guilty to mail fraud and aggravated identify theft in connection with an unemployment benefits fraud and identity theft scheme, U.S. Attorney McGregor W. Scott announced.
According to court documents, from at least December 2014 through January 2018, Herron participated in a scheme to defraud the State of California Employment Development Department (EDD) by filing fraudulent claims for unemployment insurance benefits.
In furtherance of this scheme, Herron and his co-defendant, Robert Maher, formerly of Stockton, created fictitious companies and fictitious employees (by using the real identities of persons with and without their knowledge), and filed claims with EDD, falsely stating that the employees had been laid-off or fired.
The unemployment benefits were deposited onto debit cards that were mailed to addresses controlled by Herron, Maher, or their associates. In at least one instance, ATM cameras captured Herron withdrawing unemployment benefit funds using a debit card registered to an identity theft victim. Herron was connected to approximately $578,185 in fraudulent claims to EDD, of which approximately $485,685 was paid out by EDD.
Herron is scheduled to be sentenced by U.S. District Judge John A. Mendez on July 2. Herron faces a maximum statutory penalty of 20 years in prison and a $250,000 fine for the mail fraud count, and a mandatory two-year consecutive sentence and $250,000 fine for the aggravated identity theft count. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.
This case is the product of an investigation by the U.S. Department of Labor Office of Inspector General, the Federal Bureau of Investigation, and the California Employment Development Department’s Investigation Division. Assistant U.S. Attorneys Amy Schuller Hitchcock and Shelley D. Weger are prosecuting the case.
...
According to court documents, from at least December 2014 through January 2018, Herron participated in a scheme to defraud the State of California Employment Development Department (EDD) by filing fraudulent claims for unemployment insurance benefits.
In furtherance of this scheme, Herron and his co-defendant, Robert Maher, formerly of Stockton, created fictitious companies and fictitious employees (by using the real identities of persons with and without their knowledge), and filed claims with EDD, falsely stating that the employees had been laid-off or fired.
The unemployment benefits were deposited onto debit cards that were mailed to addresses controlled by Herron, Maher, or their associates. In at least one instance, ATM cameras captured Herron withdrawing unemployment benefit funds using a debit card registered to an identity theft victim. Herron was connected to approximately $578,185 in fraudulent claims to EDD, of which approximately $485,685 was paid out by EDD.
Herron is scheduled to be sentenced by U.S. District Judge John A. Mendez on July 2. Herron faces a maximum statutory penalty of 20 years in prison and a $250,000 fine for the mail fraud count, and a mandatory two-year consecutive sentence and $250,000 fine for the aggravated identity theft count. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.
This case is the product of an investigation by the U.S. Department of Labor Office of Inspector General, the Federal Bureau of Investigation, and the California Employment Development Department’s Investigation Division. Assistant U.S. Attorneys Amy Schuller Hitchcock and Shelley D. Weger are prosecuting the case.
...
While state lawmakers are rushing to legalize cannabis for various reasons, including so called "medical reasons," and courts are moving toward approving none FDA approved cannabis for treatment of workers' compensation pain management, the medical research is trailing these decisions.
A good metaphor for this approach is "fire, ready, aim" since little is known about the relative harms of edible and inhalable cannabis products. And not all of the emerging medical research is good news for cannabis users
A new study funded by the Colorado Department of Public Health and Environment., and published in the Annals of Internal Medicine, documented a sharp rise in emergency-room visits linked with marijuana following legalization in Colorado. One of the key drivers of the ER visits was a mysterious syndrome characterized by severe nausea and repeated vomiting.
The researchers were tasked to describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. The study focused on a chart review of emergency room visits between 1 January 2012 and 31 December 2016 at a large urban academic hospital in Colorado.
They found 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis.
Very little is known about the condition, called cannabinoid hyperemesis syndrome, or CHS. Cannabinoid hyperemesis syndrome can occur with cannabis use and is characterized by recurrent nausea, vomiting, and crampy abdominal pain.
The pathogenesis of cannabinoid hyperemesis syndrome is unclear, but it may involve accumulation of exogenous cannabinoids or alterations in the brain's regulation of body temperature.
The prodromal phase is characterized by subsyndromal symptoms of cannabinoid hyperemesis syndrome, including mild discomfort and nausea upon waking. Prior to the use of compensatory exposure to hot water to treat symptoms, people sometimes increase their intake of cannabinoids in an effort to treat the persistent nausea they experience. This phase can last for months or even years
The hyperemetic phase is characterized by the full syndromal symptoms of cannabinoid hyperemesis syndrome, including persistent nausea, vomiting, abdominal pain, and retching. Retching can occur up to 5 times per hour. It is very difficult to take food or medicine by mouth during this stage, and patients may develop a fear of eating. Weight loss and dehydration due to decreased oral intake and vomiting are possible.
Compensatory exposure to hot water, even for hours at a time, may be attempted for symptomatic relief, resulting in compulsive bathing/showering. People have described the hot water relief as "temperature-dependent," meaning that hotter temperatures provide greater relief. It is during this phase that people with cannabinoid hyperemesis syndrome are likely to present to the emergency department of the hospital for treatment.
Individual attacks can lead to complications, such as acute kidney injury. In the setting of cannabinoid hyperemesis syndrome, this may be defined as cannabinoid hyperemesis acute renal failure (CHARF).
CHARF occurs through dehydration secondary due to persistent vomiting and hot showers, leading to prerenal azotemia. A case report of acute renal failure, albeit in the setting of rhabdomyolysis, has been reported with the use of synthetic cannabinoids.
While definitive treatment involves abstinence from cannabinoids, various drug therapies have been studied for symptomatic relief in the acute presentation of a patient suffering from cannabinoid hyperemesis syndrome, often in the setting of a hospital emergency department ...
A good metaphor for this approach is "fire, ready, aim" since little is known about the relative harms of edible and inhalable cannabis products. And not all of the emerging medical research is good news for cannabis users
A new study funded by the Colorado Department of Public Health and Environment., and published in the Annals of Internal Medicine, documented a sharp rise in emergency-room visits linked with marijuana following legalization in Colorado. One of the key drivers of the ER visits was a mysterious syndrome characterized by severe nausea and repeated vomiting.
The researchers were tasked to describe and compare adult emergency department (ED) visits related to edible and inhaled cannabis exposure. The study focused on a chart review of emergency room visits between 1 January 2012 and 31 December 2016 at a large urban academic hospital in Colorado.
They found 9973 visits with an ICD-9-CM or ICD-10-CM code for cannabis use. Of these, 2567 (25.7%) visits were at least partially attributable to cannabis, and 238 of those (9.3%) were related to edible cannabis.
Very little is known about the condition, called cannabinoid hyperemesis syndrome, or CHS. Cannabinoid hyperemesis syndrome can occur with cannabis use and is characterized by recurrent nausea, vomiting, and crampy abdominal pain.
The pathogenesis of cannabinoid hyperemesis syndrome is unclear, but it may involve accumulation of exogenous cannabinoids or alterations in the brain's regulation of body temperature.
The prodromal phase is characterized by subsyndromal symptoms of cannabinoid hyperemesis syndrome, including mild discomfort and nausea upon waking. Prior to the use of compensatory exposure to hot water to treat symptoms, people sometimes increase their intake of cannabinoids in an effort to treat the persistent nausea they experience. This phase can last for months or even years
The hyperemetic phase is characterized by the full syndromal symptoms of cannabinoid hyperemesis syndrome, including persistent nausea, vomiting, abdominal pain, and retching. Retching can occur up to 5 times per hour. It is very difficult to take food or medicine by mouth during this stage, and patients may develop a fear of eating. Weight loss and dehydration due to decreased oral intake and vomiting are possible.
Compensatory exposure to hot water, even for hours at a time, may be attempted for symptomatic relief, resulting in compulsive bathing/showering. People have described the hot water relief as "temperature-dependent," meaning that hotter temperatures provide greater relief. It is during this phase that people with cannabinoid hyperemesis syndrome are likely to present to the emergency department of the hospital for treatment.
Individual attacks can lead to complications, such as acute kidney injury. In the setting of cannabinoid hyperemesis syndrome, this may be defined as cannabinoid hyperemesis acute renal failure (CHARF).
CHARF occurs through dehydration secondary due to persistent vomiting and hot showers, leading to prerenal azotemia. A case report of acute renal failure, albeit in the setting of rhabdomyolysis, has been reported with the use of synthetic cannabinoids.
While definitive treatment involves abstinence from cannabinoids, various drug therapies have been studied for symptomatic relief in the acute presentation of a patient suffering from cannabinoid hyperemesis syndrome, often in the setting of a hospital emergency department ...
